Fifty years ago, a fledgling new medical school at an Ivy League university and a time-honored, if fiscally modest community hospital decided to take a risk—opening a Family Medicine residency in 1975 and later a Department of Family Medicine in 1978. The gamble was large; although Rhode Island had historically been a strong general practice state, the medical school and the hospital were moving into uncharted ground and breaking tradition with both their larger competitors north and south (Harvard and Yale) and with the direction of some of the other newly affiliated Brown hospitals. According to its first Dean, Stanley Aronson, Brown Medical School was ready to take a chance with this new field since it held significant potential for the training of well-educated physicians to meet the healthcare needs of the Rhode Island population. Also, like the Department of Community Health, where Family Medicine was originally located, it did not require the investment in laboratory infrastructure that the new medical school could little afford. Memorial Hospital of Rhode Island (MHRI) was interested in sponsoring Family Medicine because, as the CEO at the time, Mr. Frank Dietz, observed, it was consistent with the hospital’s “history and philosophical bent of primary care, general internal medicine, and prevention.” The hospital was founded through an 1894 bequest from a local mill owner to serve the workers of the Blackstone Valley and sat on the grounds of two adjoining estates. MHRI had sponsored a one-year general practice training program until the mid-1960s and wanted to reenter medical education after the affiliation with Brown. Sponsoring Family Medicine was a natural and logical development. 

However, how could one start a Family Medicine residency and department in Rhode Island? There were no faculty, no residents, no teaching practices, and no experience with this new educational model. Family Practice (FP) had begun as an approved specialty only in 1969, and knowledge of the field in the Northeast was sparse. To learn from others, the MHRI CEO, along with an influential faculty member from internal medicine, traveled to one of the early FP residencies in Hunterdon, New Jersey. Meanwhile, the first Family Medicine Division Head and later second Dean of Brown Medical School, Dr. David Greer, visited the US midwestern heartland to learn about the new specialty in Kansas City and upper Minnesota. The zealous founders of the field, the leaders of the new American Academy of Family Physicians (AAFP), were eager to help this Ivy League school make the move to Family Medicine. They imparted their wisdom to Dr. Greer during his visits and later when they came to Pawtucket to provide further input. 

Another step forward in starting the residency was catching the attention of a leading general practitioner in the Pawtucket area, Dr. John J. Cunningham. Though he may have originally been skeptical, he jumped in wholeheartedly, becoming the first medical director, faculty member, and role model. When he came to MHRI to help start the residency, he brought his long-standing practice – including patients, staff, and records – which jump-started the formation of the first Family Care Center. Dr. Cunningham also brought his approach to care, providing endless clinical pearls and helping residents distinguish between what was important and what was not. 

When the residency opened on July 1, 1975 with seven trainees, the full-time faculty consisted of Dr. Greer, Dr. Cunningham, Dr. Tom Scaramella, a psychiatrist who has been the residency director at Butler Hospital, Dr. Mary Ann Passero, a pediatrician, and Dr. John Evrard, an OB-Gyn. A psychologist, Ann DeLancey, joined soon afterward. A few local preceptors enthusiastically filled out the first faculty becoming community preceptors. The residency flourished and attracted top candidates from around the US. The class size expanded to 12 by 1977, and to 13 several years later. Starting with the first graduating class in 1978, several graduates stayed locally to practice, beginning a tradition that continues to this day with most residents practicing within an hour’s drive of the residency.

Family Care Dedication (Sept. 1975). From L to R: Charles Janeway, MD, Dr. Percy Hodgson, John J. Cunningham, MD, David S. Greer, MD, Francis R. Dietz

The next steps in the development of Family Medicine in RI involved the granting of Departmental status by Brown and the hiring of the first Department Chair in 1978. The new Department successfully recruited its first Chair, Dr. Louis Hochheiser who had served in the US military as a physician, was initially trained in pediatrics, but who moved into Family Practice early in his career. He brought new energy to the Department, which began to expand its range of faculty and activities. 

The Predoctoral division, whose goal was to teach Brown Medical students the principles of medical care and attract young physicians to the specialty, began in 1979, led by the first Predoctoral director and later Associate Dean for over twenty years, Dr. Stephen Smith. Although it took until 1995 before a required six-week clinical rotation in Family Medicine was mandated at Brown (under the guidance of Dr. Chuck Eaton), multiple courses, electives, and enrichment opportunities have always been offered. The Family Medicine clerkships (both the standard rotations and the longitudinal integrated variety), now under the direction of Dr. David Anthony and Dr. Andrea Arena, consistently receive glowing evaluations from students. 

The first researcher, Dr. Larry Culpepper arrived in 1981 and began the outstanding research tradition that continues to this day. He conducted local, national, and international research on topics as varied as otitis media and school- and community-based interventions to improve pregnancy outcomes. The tradition of research in Family Medicine was strengthened when in 1997 the Brown University Center for Primary Care and Prevention was established at MHRI (in a collaboration between Family Medicine, Internal Medicine, and Community Health/Public Health) to improve the health of individuals and communities by promoting research, enriching knowledge, and improving practice in primary care and prevention. Thomas M. Lasater, Ph.D., was its first director and Dr. Chuck Eaton succeeded him and was its first Family Medicine Director starting in 2004 with a cadre of researchers from medicine, public health, medical anthropology, psychology, and epidemiology. 

Dr. Larry Culpepper and other Family Medicine faculty were also instrumental in starting the collaborative training relationship with the Blackstone Valley Community Health Center (BVCHC) in Central Falls, a partnership that lasted for more than a decade until 2004. The partnership included BVCHC being a medical student, residency, and later a fellowship and training site and a clinical sponsor of the Maternal and Child Health fellowship until 2005. The success at BVCHC led the Department of Family Medicine to expand to other Federally Qualified Health Centers (FQHCs) in RI with fellowship positions located at East Bay, Cranston, and Thundermist federally qualified community health centers. This reflected the Department’s and the RI FQHC’s steadfast commitment to the underserved and to vulnerable populations.  In return, may Family Medicine residency graduates have joined RI health centers after graduation as clinicians, administrators, and medical directors. 

Global Family Medicine became an additional Departmental focus with the arrival of the second Chair, Dr. Vincent Hunt, who led the Department to new heights during his tenure between 1986 and 2000. Following eight years of general practice in a small rural community in northern Minnesota, Dr. Hunt returned to the University of Minnesota in 1969 as a resident in an experimental program designed to prepare practicing physicians to be Family Medicine teachers. In 1970, he joined the Department of Family Practice at Hennepin County Medical Center and became Director of the Department of Family Medicine at St. Paul Ramsey Medical Center from 1971 until 1986 when he was recruited to Brown. International collaborative educational and research projects involving the Department have taken place in Russia, Jordan, Qatar, Vietnam, Cambodia, Israel, Greece, Hungary, the Dominican Republic, Honduras, and Kenya. These projects have involved everything from the establishment of national Family Medicine training to health service planning, to providing direct service to the underserved. The approach that involves “training the trainers” has been particularly effective. Two former residents, Drs. Steve Cumming and Alain Montegut, worked for decades in Vietnam to successfully establish Family Medicine training across the country. The Shoulder-to-Shoulder partnership in Western Honduras, spearheaded by Dr. Emily Harrison and others has been in place for nearly two decades providing health care, education, nutrition, women’s empowerment, and development to one of the poorest countries in the Western Hemisphere.  A Family Medicine collaboration in Kenya with Moi University as part of the Academic Model Providing Access to Healthcare (AMPATH), now led by Dr. Daria Szkwarko with initial engagement by Dr. Kimberly Zeller, focuses on strengthening collaborative education, care, and research and supporting a bilateral exchange program for students, residents, and faculty. A Global Health Faculty Development Fellowship, started in 2012 by Dr. Fadya El Rayess, trains family medicine physicians to become global health educators, researchers, and public health experts. The fellowship partners with FQHC’s (first Thundermist and currently BVCHC) and helps to recruit and retain clinicians who work with underserved populations in RI and globally after fellowship. Dr. Daria Szkwarko took over as Director of the fellowship in 2019 and with other global health faculty such as Dr. Carolyn Pearce and Dr. Odinaka Anyanwu, the team has worked collaboratively with Moi Family Medicine colleagues on creating a decolonizing global health lecture series and recently received a large and prestigious grant from the Bill and Melinda Gates Foundation to expand point of care ultrasound training and clinical integration across six counties in western Kenya.

The Department has continued to develop and mature, taking its place among the major Family Medicine departments and training programs in the country. Fellowship training was added, starting with Maternal and Child Health in 1991 led by Dr. Brian Jack and later Dr. Rick Long, and after a hiatus, reborn under the leadership of Dr. Sue Magee in 2016, the current director.  Multiple other fellowship programs have also sprung up, sometimes lasting only years and sometimes decades. These have included the C. Everett Koop Health Policy Fellowship begun in 2003 (directed by Dr. Sean David), the Leadership Fellowship in 2004 (conceived and directed by Dr. Alicia Monroe); the Complementary Alternative Medicine Fellowship (directed by Dr. Robert Heffron and Dr. John McGonigle); the Faculty Development Fellowship (Dr. Borkan) and Sports Medicine from 2014-2018 (Dr. Jeffrey Manning and Dr. Amity Rubeor), and Global Health (mentioned above).  The recently added Diabetology Fellowship was the last to join the long tradition of fellowship training in 2024 (directed by Dr. Leonard Bertheau).

Graduates of the Brown residency and fellowship programs have become faculty across the US and the world. In addition, there has been a type of budding process whereby groups of faculty and graduates have been instrumental in initiating a residency at a health center in Lawrence, Massachusetts in 1994 and a Department of Family Medicine at Boston University, starting in 1996. 

Brown Family Medicine’s clinical footprint has expanded from its modest beginnings. In 1999, the finishing touches were put on the new Family Care Center (FCC) at MHRI, which was a state-of-the-art family medicine training center at the time. The new FCC replaced the “clinic” style facility, providing three model practices that now house the 36 residents and over 20 faculty – as well as providing a base for the successful waves of innovative programs – ranging from team-based collaboratives to PCMH (patient centered medical home), integrated behavioral health and point of care ultrasound (POCUS). 

Family Medicine residency training in RI expanded with the development the Kent Residency in 2008 – which after moving twice, found a supportive and stable home at Thundermist West Warwick Community Health Center. After the founding leadership by Dr. Polly Leonard, it was guided by Dr. Jessica Manyan who as Residency Director from 2008 to 2020.  She and the small faculty overcame multiple hurdles to create an exciting and effective training program. Though originally an Osteopathic Residency, it received Accreditation Council for Graduate Medical Education (ACGME) recognition in 2016 and merged with the Brown Family Medicine Residency, becoming a second site, soon thereafter. Since 2017 Dr. Fadya El Rayess has served as the Residency Director for both sites, with first Dr. Arnold Goldberg and as of this year Dr. Caitlin Gillooly serving as Associate Residency Directors, Dr. Jennifer Buckley (director of Kent MCH), and Dr. Meghan Grant (first director of the osteopathic curriculum). They have been “on the ground” at Thundermist and Kent leading the way and expanding the footprint of Family Medicine.

The Brown Family Medicine residency was based on the classic model of having nearly all clinical services in one site on the MHRI campus in Pawtucket.  This model worked for close to 40 years but Memorial’s fortunes worsened over time and necessitated finding a larger suitor. After a lengthy process, the hospital was acquired by Care New England (CNE) in 2013. The financial downturn was not abated however with increased costs, decreased reimbursements, and declining hospitalizations and surgeries. After unsuccessful efforts by CNE to sell off the hospital, it closed its inpatient units, starting with the beloved OB floor and ending with the closure of the Emergency and Rehabilitation Departments by January 1, 2018.  The closure of MHRI occurred in stages and was painful for all involved and left the patient population with decreased access to care. Through the valiant efforts of many, the Family Care Center survived and was expanded. The FCC opened Express Care within the FCC that facilitates seeing walk-ins and same day needs six days a week. Further heroic efforts went into maintaining the residency at the Family Care Center. The inpatient clinical needs of patients and training needs of Family Medicine residents shifted to The Miriam Hospital and Kent Hospital for adult inpatients and to Women and Infants, Kent, and Landmark for Maternal and Child Health (now called Family Medicine-Obstetrics – FM-OB).  Through hard work, luck and planning, the residency and the Department expanded to be a more “statewide” model with a more robust presence around Rhode Island.

Health policy and advocacy have been a critical component of the mission of the Department, with faculty, residents, and staff taking leadership roles in innumerable public forums, committees, and advisory boards, and even helping draft legislation to change state laws. Working closely with the Rhode Island Academy of Family Physicians on its legislative initiatives, Family Medicine has strived to make our voice heard on issues of importance to our patients and our discipline. Dr. Michael Fine, a graduate of the program, took Family Medicine advocacy leadership to the next level when he became the Director the RI Department of Health 2011-2015. Several RI Family Physicians from Dr. Sarah Fessler, to Dr. Gina LaProva, Dr. Keith Callahan, Dr. Kate de Klerk have taken leadership in advocacy and started a joint RIAFP- FM residency Advocacy Day that is now a yearly activity. The Department has also been extremely active in the Care Transformation Collaborative of RI (CTC-RI), becoming the first academic member more than a decade ago. 

In 2020, life changed across the globe as COVID-19 dominated the conversation. The Family Care Center and the Residency responded in multiple ways with faculty, residents, and staff serving as the unsung heroes of the pandemic. Early on the FCC was tasked with running an evaluation unit that was set up in tents in the parking lot to allow safe evaluation of patients.  Brown medical students and incoming interns stepped up to do phone triage prior to visits.  Through heat waves, chills and storms the outdoor unit operated and as testing became available, this service was provided for individuals in cars or who walked up, improving access and care. A ”Team D” with negative pressure rooms was quickly built in part of the old MHRI building, staffed by Family Medicine for patients with suspected COVID. Sometime up to one-third of the residents and faculty were quarantined during the epidemic, wreaking havoc on clinical services.  The response was a joint faculty/resident “Quaranteam” that provided telehealth to patients from across the Blackstone Valley. In addition, Family Medicine residents and faculty cared for patients with COVID on the inpatient services of Kent, Miriam, and Women and Infants, as well as at the temporary hospitals set up across the state. 

Dr. Jeffrey Borkan served as Chair of Family Medicine for 21 years from 2001-2022 and helped guide it through innumerable challenges, opportunities, and crises. After the merger of Memorial and CNE, he helped oversee the coming together and expansion of primary care practices across the system, led various organizational structures that integrated these practices into a service line, and worked to expand the Department to its new and expanded state-wide presence. Working with an ever growing list of partners and an enlarged faculty that reached 240 members, this resulted in initiating two adult medicine services (Kent and The Miriam hospitals), three family medicine-obstetric services (Women & Infants, Kent, and Landmark), five new fellowship programs and multiple clinical and training sites for students, residents, and fellows in every corner of Rhode Island. In addition, he provided leadership at the medical school in helping initiate the Doctoring program, the Scholarly Concentration program, and the Primary Care-Population Medicine program and he is now the Assistant Dean for Primary Care-Population Health at Brown. 

The Department has recently jumped to a new level under the leadership of Dr. Caroline Richardson – an internationally recognized researcher and journal editor who became Chair of Family Medicine at Brown in 2022. With major support from both CNE and Brown, she was successfully recruited to RI and received the first endowed chair in Family Medicine (the George A. and Marilyn M. Bray). Working together with our partners, she has been tirelessly striving to improve clinical services, strengthen teaching, and revitalize research in the Department.  In addition, she has initiated both a Diabetology service at CNE and a Diabetology fellowship and brought the Annals of Family Medicine, the leading family medicine journal in the US, to Brown. 

Brown Family Medicine’s achievements in the last 50 years have been impressive no matter how you look at it: more than 620 graduates of the residency who have literally cared for millions of patients and families in their communities, 1000s of academic articles expanding the science of primary care, 1000s of students trained, and primary care altered for the better throughout RI, the Northeast, the US, and the globe.  At least 40%-50% of the Family Doctors in RI were trained in the residency program and there are now more than 200 Brown Family Medicine faculty in the state, including everyone from instructors to associate deans. Through it all, Brown Family Medicine has remained true to its roots. We look forward to the next 50 years, and plan to continue our cutting-edge contributions in clinical care, research, education, and advocacy. Our partnerships now span Rhode Island, the nation, and the globe, and we are committed to work together to improve the health of our population at every opportunity. We take this opportunity to celebrate and to thank all those who have played a role, as we gather our strength to meet the challenges ahead.  What will the next 50 years bring? One can only dream! 

Lists of Founders, Past Residency Directors and Chairs